Orthodox Jews and factors affecting COVID-19 vaccination: Lessons learned for public health

BACKGROUND: Orthodox Jews in general, and Haredi (often called Ultra-Orthodox) Jews in particular, have been disproportionately harmed by the COVID-19 pandemic and are typically less vaccinated. However, not enough is known about causal factors, especially social and religious factors, and the interactions between them. AIM: To determine what influences COVID-19 vaccination among Orthodox Jews in the U.S.. METHODS: U.S. Orthodox Jewish communities across seven states were surveyed using a convenience sample. Questions were asked about COVID-19-related behaviors and attitudes, religious behaviors and attitudes, information sources, trust in health experts, and sociodemographics. The primary outcome measure was vaccination status. Descriptive analyses and multivariable modified Poisson regressions were performed. RESULTS: There were 3,249 respondents. Haredi Jews were less likely to vaccinate than other Orthodox Jews but more likely to have had COVID-19 and believe vaccination was unnecessary. Distrust of COVID-19 information from health experts was high across communities, highest for Haredi Jews. Multivariable regressions showed significantly reduced risk of not being vaccinated across communities when friends were vaccinated and when spiritual leaders supported vaccination. Impact of personal doctors endorsing the vaccine was more limited. Concerns about COVID-19 vaccine safety, but not effectiveness, impacted vaccination rates. DISCUSSION: Trust-building and increased cultural competence can help public health systems and other health entities work more effectively with Orthodox Jews, especially Haredim. The social environment of these groups, including friends and spiritual advisers, may also be underutilized pathways to increasing vaccination. These steps can potentially reduce health inequalities and improve health in these communities not only for COVD-19 but other health issues in the future. KEY MESSAGES: • Religious attitudes and beliefs can affect vaccination rates for a number of reasons. • There is a need for increased trust and greater partnership between the faith-based and public health communities.